Notices
Federal law requires that Coriant provide you with certain notices about your rights regarding health care plan eligibility, enrollment, and coverage.
Notice of Special Enrollment Rights for Medical Plan Coverage
Special enrollment events allow you and your eligible dependents to enroll for health coverage outside the Open Enrollment period under certain circumstances if you lose eligibility for other coverage, become eligible for state premium assistance under Medicaid or the Children’s Health Insurance Program (CHIP), or acquire newly eligible dependents. This is required under the Health Insurance Portability and Accountability Act (HIPAA). If you decline enrollment in Coriant medical plan for you or your dependents (including your spouse/domestic partner) because of other health insurance coverage or group health plan coverage, you or your dependents may be able to enroll in Coriant medical plan without waiting for the next Open Enrollment period if you:
• Lose other health insurance or group health plan coverage. You must request enrollment within 30 days after the loss of other coverage.
• Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
• Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request enrollment within 60 days after the loss of such coverage.
If you request a change due to a special enrollment event within the 30-day timeframe, coverage will be effective the date of birth, adoption, or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. In addition, you may enroll in Coriant medical plan if you become eligible for a state premium assistance program under Medicaid or CHIP, you must request enrollment within 60 days after you gain eligibility for such coverage. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law. If you have questions, or to notify the plan, contact Benefits. Note: If your dependent becomes eligible for a special enrollment rights, you may add the dependent to your current coverage or change to another health plan. Any other currently covered dependents may also switch to the new plan in which you enroll.
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Women’s Health and Cancer Rights Act of 1998
If you or one of your covered dependents has had or is going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided for the following services in a manner determined in consultation with the attending physician and the patient:
• All stages of reconstruction of the breast on which the mastectomy was performed
• Surgery and reconstruction of the other breast to produce a symmetrical appearance
• Prostheses
• Treatment of physical complications of all stages of the mastectomy, including lymphedemas.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits available under your medical plan.
For information on WHCRA benefits or details about any state laws that may apply to your medical plan, please refer to the benefit plan material for the medical plan in which you are enrolled.
Newborns’ and Mothers’ Health Protection Act
Federal law protects the benefit rights of mothers and newborns related to any hospital stay in connection with childbirth. In general, group health plans and health insurance issuers may not:
• Restrict benefits for the length of hospital stay for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable).
• Require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay of up to 48 hours (or 96 hours).
For details on any state maternity laws that may apply to your medical plan, please refer to the benefits material for the medical plan in which you are enrolled.
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Consolidated Omnibus Budget Reconciliation Act (COBRA)
If you’re an employee with medical, dental, or vision coverage through Coriant, you have the right to choose continuation coverage if you lose your group health coverage due to reduction in your hours of employment or the termination of your employment for reasons other than gross misconduct. Your eligible dependents may also have the right to elect and pay for continuation of coverage for a temporary period in certain circumstances where coverage under the plan would otherwise end, such as divorce, or dependent children who no longer meet eligibility requirements.
Important note: This brief summary of the right you and your dependents have to continue insurance is not intended as the official notice of your rights required by federal and state law. We’ve included this brief summary to inform you that you have these rights. You’ll receive a separate, detailed explanation of your right to continue health insurance coverage when applicable. Specific information is also available from your HR representative.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, you can contact your state Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your state Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2016. You should contact your state for further information on eligibility.
Alabama – Medicaid / Website: http://www.myalhipp.comPhone: 1-855-692-5447
Alaska – Medicaid / Website: http://myakhipp.com/
Phone: 1-866-251-4861
Email:
Medicaid Eligibility:
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Arizona – CHIP / Website: https://www.azahcccs.gov
Phone (Outside Maricopa County): 1-800-654-8713
Phone (Maricopa County): 1-602-417-4000
Phone (Out-of-State): 1-800-523-0231
Arkansas — CHIP / Website: http://myarhipp.com/
Phone: 1-855-MyARHIPP (1-855-692-7447)
California – Medi-Cal / Website: http://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx
Phone: 1-916-552-9200 (Medi-Cal eligibility line)
Email: (Health Insurance Premium Payment email)
Colorado – Medicaid / Website: http://www.colorado.gov/hcpf
Phone: 1-800-221-3943
Florida – Medicaid / Website: http://flmedicaidtplrecovery.com/hipp/
Phone: 1-877-357-3268
Georgia – Medicaid / Website: http://dch.georgia.gov/medicaid (Click Health Insurance Premium Payment (HIPP))
Phone: 1-678-564-1162
Idaho – Medicaid and CHIP / Website: http://healthandwelfare.idaho.gov/FoodCashAssistance/HealthCoverageAssistance/tabid/2882/Default.aspx
Phone: 1-877-456-1233
Indiana – Medicaid / Website: http://www.hip.in.gov (Health Indiana Plan for low-income adults 19-64)
Phone: 1-877-438-4479
Website: http://www.indianamedicaid.com (All other Medicaid)
Phone: 1-800-403-0964
Iowa – Medicaid / Website: http://www.dhs.state.ia.us/hipp/
Phone: 1-888-346-9562
Kansas – Medicaid / Website: http://www.kdheks.gov/hcf/
Phone: 1-800-792-4884
Phone (In-state): 1-785-296-3512
Kentucky – Medicaid / Website: http://chfs.ky.gov/dms/default.htm
Phone: 1-800-635-2570
Louisiana – Medicaid / Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
Phone: 1-888-342-6207
Maine – Medicaid / Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html
Phone: 1-800-442-6003
TTY: Maine relay 711
Massachusetts – Medicaid and CHIP / Medicaid & CHIP Website: http://www.mass.gov/MassHealth
Medicaid & CHIP Phone: 1-800-462-1120
Minnesota – Medicaid / Website: http://mn.gov/dhs/ma/
Phone (Outside Twin City area): 1-800-657-3739
Phone (Twin City area): 1-651-431-2670
Missouri – Medicaid / Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 1-573-751-2005
Montana – Medicaid / Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084
Nebraska – Medicaid / Website: http://www.ACCESSNebraska.ne.gov
Phone: 1-855-632-7633
Nevada – Medicaid / Website: http://dwss.nv.gov/
Phone: 1-800-992-0900
New Hampshire – Medicaid / Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf
Phone: 1-603-271-5218
New Jersey – Medicaid and CHIP / Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/
Medicaid Phone: 1-800-356-1561
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710
New Mexico – Medicaid and CHIP / Medicaid & CHIP Website: http://www.hsd.state.nm.us/mad/index.html
Medicaid & CHIP Phone: 1-888-997-2583
New York – Medicaid / Website: http://www.nyhealth.gov/health_care/medicaid/
Phone: 1-800-541-2831
North Carolina – Medicaid / Website: http://www.ncdhhs.gov/dma/medicaid/hipp.htm
Phone: 1-919-855-4100 (Main office)
Phone: 1-855-696-2447 (HIPP)
North Dakota – Medicaid / Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 1-844-854-4825
Oklahoma – Medicaid / Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
Oregon – Medicaid and CHIP / Medicaid & CHIP Website: http://healthcare.oregon.gov/Pages/index.aspx
Medicaid & CHIP Phone: 1-800-699-9075
Pennsylvania – Medicaid / Website: http://www.dhs.pa.gov/hipp
Phone: 1-800-692-7462
Rhode Island – Medicaid / Website: http://www.eohhs.ri.gov/
Phone: 1-401-462-5300
South Carolina – Medicaid / Website: http://www.scdhhs.gov
Phone: 1-888-549-0820 (Member Information)
Phone: 1-803-264-6838/6847 (HIPP line)
South Dakota – Medicaid / Website: http://dss.sd.gov
Phone: 1-888-828-0059
Texas – Medicaid / Website: http://www.gethipptexas.com/
Phone: 1-800-440-0493
Utah – Medicaid and CHIP / Medicaid Website: http://health.utah.gov/medicaid
CHIP Website: http://health.utah.gov/chip
Phone: 1-866-435-7414 (DWS for Premium Payment Assistance)
Medicaid Phone: 1-801-538-6155
CHIP Phone: 1-877-543-7669 (1-877-KIDSNOW)
Vermont– Medicaid / Website: http://www.greenmountaincare.org
Phone: 1-800-250-8427
Virginia – Medicaid and CHIP / Medicaid & CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm
Medicaid & CHIP Phone: 1-855-242-8282
Washington – Medicaid / Website: http://www.hca.wa.gov/medicaid/premiumpymt/Pages/index.aspx
Phone: 1-800-562-3022, ext. 15473
West Virginia – Medicaid / Website: http://www.wvrecovery.com/hipp.asp
Phone: 1-877-598-5820, HMS Third Party Liability
Wisconsin – Medicaid / Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm
Phone: 1-800-362-3002
Wyoming – Medicaid / Website: http://www.health.wyo.gov/healthcarefin/index.html
Phone: 1-307-777-7531
To see if any more states have added a premium assistance program since July 31, 2016, or for more information on special enrollment rights, you can contact either:
U.S. Department of LaborEmployee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272) / U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) informs you how the plan uses and discloses your health information and explains your rights with regard to your health information maintained by the plan.
In compliance with HIPAA, our Privacy Notice is included below. Please carefully review this notice. It describes how medical information about you may be used and disclosed and how you can get access to this information.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on the use and disclosure of individual health information by Coriant health plans. This information, known as protected health information, includes almost all individually identifiable health information held by a plan — whether received in writing, in an electronic medium, or as an oral communication. This notice describes the privacy practices of Coriant Welfare Benefit Plan and Summary Plan Description (the “Plan”).
The Plan’s duties with respect to health information about you
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. If you participate in an insured plan option, you will receive a notice directly from the Insurer. It’s important to note that these rules apply to the Plan, not Coriant as an employer — that’s the way the HIPAA rules work. Different policies may apply to other Coriant programs or to data unrelated to the Plan.
How the Plan may use or disclose your health information
The privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of health care treatment, payment activities, and health care operations. Here are some examples of what that might entail:
§ Treatment includes providing, coordinating, or managing health care by one or more health care providers or doctors. Treatment can also include coordination or management of care between a provider and a third party, and consultation and referrals between providers. For example, the Plan may share your health information with physicians who are treating you.
§ Payment includes activities by this Plan, other plans, or providers to obtain premiums, make coverage determinations, and provide reimbursement for health care. This can include determining eligibility, reviewing services for medical necessity or appropriateness, engaging in utilization management activities, claims management, and billing; as well as performing “behind the scenes” plan functions, such as risk adjustment, collection, or reinsurance. For example, the Plan may share information about your coverage or the expenses you have incurred with another health plan to coordinate payment of benefits.
§ Health care operations include activities by this Plan (and, in limited circumstances, by other plans or providers), such as wellness and risk assessment programs, quality assessment and improvement activities, customer service, and internal grievance resolution. Health care operations also include evaluating vendors; engaging in credentialing, training, and accreditation activities; performing underwriting or premium rating; arranging for medical review and audit activities; and conducting business planning and development. For example, the Plan may use information about your claims to audit the third parties that approve payment for Plan benefits.